Appropriate Needle Lengths Determined Using Ultrasonic Echograms for Intramuscular Injections in Japanese Infants

Adjuvanted vaccines are recommended for administration through an intramuscular route. The Centers for Disease Control and Prevention (CDC) has recommended the anterolateral thigh using a 22 - 25-G 25-mm (1 inch) needle for infants, injected at a 90° into the skin surface, and using a 16 mm (5/8 inch) for newborns. Appropriate needle lengths may differ depending on racial backgrounds. In the present study, the thickness of the epidermis and lengths from the skin surface to the muscle fascia and bone were measured using ultrasonic echograms in order to determine suitable needle lengths for Japanese infants aged 2, 3, 4, 5, 6, and 12 - 15 months old. The thickness of the epidermis was 1.44 - 1.54 mm (95% CI), and the lengths from the skin surface to the muscle fascia and bone were 11.52 - 12.28 mm (95% CI), and 25.66 - 26.93 mm (95% CI), respectively, at the anterolateral thigh. At the center of the deltoid muscle, skin thickness was similar to that at the thigh, furthermore the lengths from the skin surface to the muscle fascia and bone were 8.49 - 9.10 mm (95% CI), and 17.38 - 18.31 mm (95% CI), respectively. The lengths from the skin surface to the muscle fascia and bone were 1 - 2 mm shorter in 2-month-old infants than those in older generations. Therefore, the appropriate needle length for intramuscular injections in Japanese infants was 16 mm (5/8 inch) at any age and sites, and with 25 mm (1 inch) needles at a 90° angle being associated with the risk of over-penetration.

A narrative review of the success of intramuscular gluteal injections and its impact in psychiatry

There are 12 billion injections given worldwide every year. For many injections, the intramuscular route is favoured over the subcutaneous route due to the increased vascularity of muscle tissue and the corresponding increase in the bioavailability of drugs when administered intramuscularly. This paper is a review of the variables that affect the success of intramuscular injections and the implications that these success rates have in psychiatry and general medicine. Studies have shown that the success rates of intended intramuscular injections vary between 32 and 52%, with the rest potentially resulting in inadvertent subcutaneous drug deposition. These rates are found to be even lower for certain at-risk populations, such as obese patients and those on antipsychotic medications. The variables associated with an increased risk of injection failure include female sex, obesity, site of injection, and subcutaneous fat depth. New guidelines and methods are needed in order to address this challenge and ensure that patients receive optimum care. Looking forward, the best way to improve the delivery of intramuscular injections worldwide is to develop uniform algorithms or innovative medical devices to confirm or guarantee successful delivery at the bedside.

ShotBlocker versus cryotherapy for reducing pain and anxiety associated with subcutaneous injection

Objective:To determine and compare the abilities of Shot Blocker and cryotherapy for reducing pain and anxiety associated with subcutaneous injections.Subcutaneous injection has been used excessively for continuous,low-dose administration of drugs.Considering that these drugs may require prolonged administration,new devices and methods of injection are needed to decrease pain and anxiety associated with repeated drug injections.Methods:A quasi-experimental study design on a purposive sample of 54 patients comprised of both sexes has been utilized.The subjects were divided into 2 equal groups(group 1,Shot Blocker;group 2,cryotherapy),and 3 tools were used,namely the sociodemographic and medical data sheet,Verbal Descriptor Scale for measuring pain,and Beck Anxiety Inventory.Results:A significant reduction in pain and anxiety mean scores was observed after using cryotherapy and Shot Blocker techniques during subcutaneous injection.In addition,the Shot Blocker group exhibited significantly lower pain and anxiety mean scores compared with the cryotherapy group.Conclusions:Our findings revealed that Shot Blocker and cryotherapy were effective non-pharmacological methods for reducing pain and anxiety levels associated with repeated subcutaneous injections.

The effect of subcutaneous injection duration on patients receiving low-molecular-weight heparin:Evidence from a systematic review

To assess the effect of the injection duration of subcutaneous low-molecular-weight heparin(LMWH)on pain and bruising in patients.Randomized controlled trials and quasiexperimental studies were searched for in four electronic databases.The pooled effect size was expressed as relative risk(RR)andmeandifference(MD)with95%confidence intervals(CI)for dichotomous and continuous data.Cochrane Q and p value were used to assess heterogeneity and the I2 statistic was adopted to quantify the level.Finally,eight studies involving a total of 532 participants met our inclusion criteria.The slow(30 second)injection was associated with a reduction in pain intensity and duration,and lower bruising occurrence at 48-72 hours and 48 hours post injection.The bruising area was also smaller at 48 hours and 60 hours post injection.Nodifferenceswere identified betweenthe slowand fast(10 second)injectionin bruising area and bruising occurrence at 24 hours and 60 hours post injection.With present evidences,slow injection of LMWH is beneficial to the patient's well being,but further studies to identify the feasibility and standardization of the technique is recommended.

The effect of cryotherapy application before versus after subcutaneous anticoagulant injection on pain intensity and hematoma formation: A quasi-experimental design

Objective:To investigate the effect of cryotherapy application before versus after subcutaneous anticoagulant injection(SCAI)on pain intensity and hematoma formation.Methods:A quasi-experimental design was utilized.A convenient sample of 105 adult patients,who were admitted to one of the biggest teaching hospitals in Cairo and receiving SCAI,were recruited over a period of six months.Patients were randomly allocated into three groups:A Control group who received the routine hospital care(G1,n=35)and two intervention group who received cryotherapy for 5-min(G2:cryotherapy applied before SCAI,n=35;G3:cryotherapy applied after SCAI,n=35).Demographic and medical history data sheet,Pain Numeric Rating Scale and Hematoma Formation and Size Assessment Scale were used to collect the data.Results:The pain intensity among the patients in the two intervention groups(G2:Median=1.0;G3:Median=0)was significantly lower than in the control group(G1,Median=3.0).No significant difference was found between G2 and G3(P=0.728).Applying cryotherapy after SCAI(G3)decreased the frequency of hematoma formation(48hrs=31.4%&72hrs=28.5%)compared to applying it before injection(G2,100%)or not applying it(G1,100%).The size of hematoma in G3 was smaller than that in G2(P<0.01).Conclusion:Applying cryotherapy significantly decreased pain intensity and hematoma occurrence/size.Applying cryotherapy after injection was more effective in preventing hematoma formation and decreasing its size than applying it before injection.

Comparative effects of insulin pump and injection on gestational diabetes mellitus pregnancy outcomes and serum biomarkers

BACKGROUND Insulin injection is the basic daily drug treatment for diabetic patients.AIM To evaluate the comparative impacts of continuous subcutaneous insulin infusion(CSII).METHODS Based on the treatment modality received,the patients were allocated into two cohorts:The CSII group and the multiple daily injections(MDI)group,with each cohort comprising 210 patients.Comparative assessments were made regarding serum levels of serum-secreted frizzled-related protein 5,homocysteine,and C1q/TNF-related protein 9.Furthermore,outcomes such as fasting plasma glucose,2-hour postprandial glucose levels,pain assessment scores,and the incidence of complications were evaluated post-treatment.RESULTS The CSII group displayed notably lower fasting plasma glucose and 2-h postprandial glucose levels in comparison to the MDI group(P<0.05).Subsequent analysis post-treatment unveiled a significantly higher percentage of patients reporting no pain in the CSII group(60.00%)in contrast to the MDI group(36.19%)(P<0.05).Additionally,the CSII group exhibited a markedly reduced occurrence of fetal distress and premature rupture of membranes compared to the MDI group(P<0.05).However,there were no significant variances observed in other pregnancy outcomes between the two groups(P>0.05).A statistical analysis revealed a significant difference in the incidence of complications between the groups(χ^(2)=11.631,P=0.001).CONCLUSION The utilization of CSII via an insulin pump,as opposed to MDI,can significantly enhance the management of insulin administration in patients with GDM by diversifying the sites of insulin delivery.This approach not only promotes optimal glycemic control but also regulates metabolic factors linked to blood sugar,reducing the likelihood of adverse pregnancy outcomes and complications.The clinical relevance and importance of CSII in GDM management highlight its wide-ranging clinical usefulness.

Rapid and sensitive liquid chromatography–tandem mass spectrometric method for the quantitative determination of potentially harmful substance 5,5′-oxydimethylenebis (2-furfural) in traditional Chinese medicine injections

With the rapid development and wide application of traditional Chinese medicine injection(TCMI), a number of adverse events of some TCMIs have incessantly been reported and have drawn broad attention in recent years. Establishing effective and practical analytical methods for safety evaluation and quality control of TCMI can help to improve the safety of TCMIs in clinical applications. In this study, a sensitive and rapid high-performance liquid chromatography–tandem mass spectrometry(HPLC–MS/MS)method has been developed and validated for the quantitative determination of potentially harmful substance5,5′-oxydimethylenebis(2-furfural, OMBF) in TCMI samples. Chromatographic separation was performed on a C18 reversed-phase column(150 mm × 2.1 mm, 5 μm) by gradient elution, using methanol–water containing 0.1% formic acid as mobile phase at the flow rate of 0.3 m L/min. MS/MS detection was performed on a triple quadrupole mass spectrometer with positive electrospray ionization in the multiple reaction-monitoring mode. The method was sensitive with a limit of quantification of 0.3 ng/m L and linear over the range of 0.3–30 ng/m L(r = 0.9998). Intra-and inter-day precision for analyte was o9.52% RSD withrecoveries in the range 88.0–109.67% at three concentration levels. The validated method was successfully applied to quantitatively determine the compound OMBF in TCMIs and glucose injections. Our study indicates that this method is simple, sensitive, practicable and reliable, and could be applied for safety evaluation and quality control of TCMIs and glucose injections.

The relationship between body mass index, thickness of subcutaneous fat, and the gluteus muscle as the intramuscular injection site

An intramuscular injection (IMI) is an injection given directly into the central area of a specific muscle. Certain medicines need to be administered by the gluteal route for these to be effective. The aim of this study was to determine the influence of body mass index (BMI), subcutaneous fat, and muscular thickness of the dorsogluteal IMI site among healthy Japanese women. There were 39 healthy female subjects who volunteered and met the criteria. Their ages ranged from 40s to 60s (50.82 ± 6.04). With the data collected using the B-mode ultrasound images of the dorsogluteal site, it was found that the distance from the epidermis to the under-fascia (DEUF) of the gluteus maximus was dissimilar between the subject’s right and left buttocks. It was found that the distance from the epidermis to the iliac bone (DEI) was significantly more on the right than on the left buttocks. In the case of an adult Japanese woman with a BMI of 21 or more, the DEUF of the gluteus medius was found to be about 30 mm, and the DEI was approximately 50 mm or more. Based on these findings, it is recommended that a needle length of 38 mm (1.5 inches) can be safely used to administer IMIs to the gluteus medius muscle to effectively and efficiently deliver medications through the IMI route.

Oil oxidation in the whole temperature regions during oil reservoir air injection and development methods

The oil oxidation characteristics of the whole temperature regions from 30 ℃ to 600 ℃ during oil reservoir air injection were revealed by experiments. The whole oil oxidation temperature regions were divided into four different parts: dissolving and inflation region, low temperature oxidation region, medium temperature oxidation region and high temperature oxidation region. The reaction mechanisms of different regions were explained. Based on the oil oxidation characteristics and filed tests results, light oil reservoirs air injection development methods were divided into two types: oxygen-reducing air flooding and air flooding;heavy oil reservoirs air injection in-situ combustion development methods were divided into two types: medium temperature in-situ combustion and high temperature in-situ combustion. When the reservoir temperature is lower than 120 ℃, oxygen-reducing air flooding should be used for light oil reservoir development. When the reservoir temperature is higher than 120 ℃, air flooding method should be used for light oil reservoir development. For a normal heavy oil reservoir, when the combustion front temperature is lower than 400 ℃, the development method is medium temperature in-situ combustion. For a heavy oil reservoir with high oil resin and asphalting contents, when the combustion front temperature is higher than 450 ℃, the development method at this condition is high temperature in-situ combustion. Ten years field tests of air injection carried out by PetroChina proved that air has advantages in technical, economical and gas source aspects compared with other gas agents for oilfield gas injection development. Air injection development can be used in low/super-low permeability light oil reservoirs, medium and high permeability light oil reservoirs and heavy oil reservoirs. Air is a very promising gas flooding agent.

Experimental study on secondary air mixing along the bed height in a circulating fluidized bed with a multitracer-gas method

A multitracer-gas method was proposed to study the secondary air(SA)mixing along the bed height in a circulating fluidized bed(CFB)using carbon monoxide(CO),oxygen(O_(2)),and carbon dioxide(CO_(2))as tracer gases.Experiments were carried out on a cold CFB test rig with a cross-section of 0.42 m×0.73 m and a height of 5.50 m.The effects of superficial velocity,SA ratio,bed inventory,and particle diameter on the SA mixing were investigated.The results indicate that there are some differences in the measurement results obtained using different tracer gases,wherein the deviation between CO and CO_(2) ranges from 42%to 66%and that between O_(2) and CO_(2) ranges from 45%to 71%in the lower part of the fluidized bed.However,these differences became less pronounced as the bed height increased.Besides,the high solid concentration and fine particle diameter in the CFB may weaken the difference.The measurement results of different tracer gases show the same trends under the variation of operating parameters.Increasing superficial velocity and SA ratio and decreasing particle diameter result in better mixing of the SA.The effect of bed inventory on SA mixing is not monotonic.

Comparison of the single-injection volar subcutaneous block and the two-injection dorsal block for digital anesthesia

Objectives: Local digital nerve blockade is frequently used in many trauma cases. Two commonly used techniques of digital nerve block with local anesthetic are the two-injection dorsal technique and the single-injection volar subcutaneous technique. In this study we compare various parameters of the single-injection volar subcutaneous block and the two-injection dorsal block. Pain score, amount of injected anesthetic, time of effect onset, patients’ and physicians’ satisfaction scores in each injection technique was compared. Methods: 128 participating patients were randomly divided into two equal experimental groups. Two-percentage Lidocaine was used as an anesthetic agent. Doses of 1.8 and 3-4 ml were used in the single-injection subcutaneous block and the two-injection dorsal block groups, respectively. Following injections, the patients were asked to score their discomfort experience on a standard visual analog scale of 0 (no pain) to 10 (most pain imaginable). They also were asked to score the rate of their satisfaction from 1(no satisfaction) to 5 (most satisfaction). The onset of effect was determined using the pinprick test. Results: Our results demonstrate that the two-injection dorsal block technique imposes more pain but the pain score difference was not statistically significant. Both patients and physicians were more comfortable with the single-injection subcutaneous digital block method. This satisfaction difference was statistically significant. Conclusions: The single-injection method is more efficient and the patients were more pleased. The advantages of this method are its safety, user friendly, need of lower amount of anesthetic drug and its easiness to teach and learn.

A HPLC Method for the Determination of Salmon Calcitonin in Injection by Gradient Elution

It was concluded that the described HPLC method could be used for the assayof salmon calcitonin in injection, as it offers qualified selectivity, accuracy and precision ofanalysis.

Efficacy of Subcutaneous Administration of Gonadotropin-releasing Hormone Agonist on Idiopathic Central Precocious Puberty

In order to assess the feasibility of subcutaneous administration of Triptorelin with 6-week intervals for the suppression of pituitary-gonadal axis and changes of clinical signs in girls with idiopathic central precocious puberty （ICPP）, 46 girls with ICPP were treated with GnRHa. Triptorelin （Decapeptyl, 3.75 mg） was administered subcutaneously （SC） at 6-weeks intervals or intramuscularly （IM） at 4-weeks intervals randomly for more than 12 months consecutively. During GnRHa therapy, clinical parameters and laboratory data, including height, weight, pubertal stage, bone age, uterine volume and ovarian size, serum levels of luteinizing hormone （LH）, follicle stimulating hormone （FSH） and estradiol （E2）, were monitored and analyzed. It was found that both treatment regimes led to regression of precocious puberty and reversal of secondary sexual characteristics. Breast developments regressed. Uterine volume was decreased after treatment, but there was no statistically significant difference. Mean ovarian volume did not change significantly during treatment. The height velocity was decreased significandy from 6.3±1.4 cm/year to 5.8：1：1.2 cm/year in group SC and 6.7±1.3 cm/year to 5.4±1.0 cm/year in group IM, respectively. The rate of bone maturation was reduced significantly during treatment. The ratio of deltaBAgdeltaCA was 1.2±0.2 or 1.3±0.3 at the onset of therapy and decreased significantly after the treatment to 0.7±0.2 or 0.9±0.1, respectively. The predicted adult height was increased significantly and progressively during therapy. The levels of serum LH, FSH and E2 returned to the prepubertal condition. No significant side effects of therapy were noted. The most common side effect during SC treatment was that a non-irritating, 1 cm in di- ameter mass was palpated at the site of subcutaneous injection in the abdominal wall of patients, which disappeared after 6- 12 weeks. Two girls had minimal withdrawal vaginal bleeding episodes after the first injection. It was concluded that both IM and SC triptorelin administrations were clinically effective. They induce profound suppression of hypothalamic-pituitary-gonadal axis while stabilizing height velocity, slowing bone maturation and increasing predicted adult height. These results suggest that subcutaneous injection of triptorelin in 6-weeks intervals at a dosage of 3.75 mg be a safe and acceptable regimen for ICPP.

Simulation of Non-isothermal Injection Molding for a Non-Newtonian Fluid by Level Set Method

A non-isothermal injection molding process for a non-Newtonian viscous pseudoplastic fluid is simulated.A conservative interface capturing technique and the flow field solving method are coupled to perform a dynamic simulation.The validity of the numerical method is verified by a benchmark problem.The melt interface evolution versus time is captured and the physical quantities such as temperature,velocity and pressure at each time step are obtained with corresponding analysis.A"frozen skin"layer with the thickness increasing versus time during the injection process is found.The fact that the"frozen skin"layer can be reduced by increasing the injection velocity is numerically verified.The fountain flow phenomenon near the melt interface is also captured.Moreover,comparisons with the non-isothermal Newtonian case show that the curvatures of the interface arcs and the pressure contours near the horizontal mid-line of the cavity for the non-Newtonian pseudoplastic case is larger than that for the Newtonian case.The velocity profiles are different at different positions for the non-Newtonian pseudoplastic case,while in the case of Newtonian flow the velocity profiles are parabolic and almost the same at different positions.

A fast explicit finite difference method for determination of wellhead injection pressure

A fast explicit finite difference method (FEFDM),derived from the differential equations of one-dimensional steady pipe flow,was presented for calculation of wellhead injection pressure.Recalculation with a traditional numerical method of the same equations corroborates well the reliability and rate of FEFDM.Moreover,a flow rate estimate method was developed for the project whose injection rate has not been clearly determined.A wellhead pressure regime determined by this method was successfully applied to the trial injection operations in Shihezi formation of Shenhua CCS Project,which is a good practice verification of FEFDM.At last,this method was used to evaluate the effect of friction and acceleration terms on the flow equation on the wellhead pressure.The result shows that for deep wellbore,the friction term can be omitted when flow rate is low and in a wide range of velocity the acceleration term can always be deleted.It is also shown that with flow rate increasing,the friction term can no longer be neglected.

New approach to develop a 3D non-isothermal computational framework for injection molding process based on level set method

The simulation of three-dimensional （3D） non-isothermal, non-Newtonian fluid filling process is an extremely difficult task and remains a challenging problem, which includes polymer melt flow with free surface coupled with transient heat transfer. This paper presents a full 3D non-isothermal two-phase flow model to predict the complex flow in melt filling process, where the Cross-WLF model is applied to characterize the rheological behav- ior of polymer melt. The governing equations are solved using finite volume method with SIMPLEC algorithm on collocated grids and the melt front is accurately captured by a high resolution level set method. A domain exten- sion technique is adopted to deal with the complex cavities, which greatly reduces the computational burden. To verify the validity of the developed 3D approach, the melts filling processes in two thin rectangular cavities （one of them with a cylindrical insert） are simulated. The predicted melt front interfaces are in good agreement with the experiment and commercial software prediction. For a case with a rather complex cavity, the dynamic filling process in a hemispherical shell is successfully simulated. All of the numerical results show that the developed numerical procedure can provide a reasonable orediction for injection molding process.

Density Limits with Different Fuelling Methods in the HL-2A Tokamak

Density limits with different fuelling methods have been compared in HL-2A, i.e. direct gas puffing and supersonic molecular beam injection （SMBI） from outer midplane, and divertor gas fuelling. The maximum densities for low current discharges are 3.4×10^19 m-3, 4.3×10^19 m-3 and 4.7×10^19 m-3 for the 3 kinds of fuelling methods. The corresponding density ratios to Green- wald density limit are 0.9, 1.1, 1.2, respectively. The behavior of density limit disruption is analyzed as well.

Power System State Estimation Solution With Zero Injection Constraints Using Modified Newton Method and Fast Decoupled Method in Polar Coordinate

如何保证零注入节点的注入功率在状态估计结果中严格为0是电力系统状态估计研究中的重要问题。在直角坐标下,由于零注入约束为线性约束,可使用修正牛顿法来有效地解决这一问题。因此,借鉴直角坐标下修正牛顿法的思路,提出了极坐标下的修正牛顿法和修正快速解耦估计。这些方法的计算流程与传统的极坐标下的牛顿法和快速解耦估计非常相似,计算速度与大权重法相当,同时能够保证零注入约束严格满足。仿真结果验证了所得结论。

Change of Subcutaneous Tissue Mass at the Deltoid and Thigh Areas in Japanese Infants Followed from 2 to 15 Months

We previously investigated the thickness of the epidermis and lengths from the skin surface to the muscle fascia and bone based on measurements taken from the ultrasonic echograms of Japanese infants aged 2, 3, 4, 5, 6, and 12 - 15 months. The appropriate needle length for intramuscular injection was 16 mm (5/8 inch) in Japanese infants at any age and site. In the present study, we examined these lengths in 21 infants with physical growth from 2 to 15 months. Average height increased from 58.5 to 73.6 cm and average body weight from 5835 to 9226 g until 15 months. The circumference of the thigh increased from 22.3 cm at 2 months to a maximum of 25.9 cm at 6 months, while that of the deltoid area was 15.2 cm at 2 months and 15.9 cm at 6 months. Subcutaneous mass (length from the skin surface to the muscle fascia) at the thigh increased between 3 and 4 months and decreased at 12 - 15 months and showed good relationship to the circumference of the thigh. Subcutaneous mass at the center of the deltoid area showed the same size until 6 months. Muscle mass (lengths from the muscle fascia to the bone) at thigh and deltoid areas remained the same until 6 months. Ultrasonic echogram is an effective tool for evaluating subcutaneous and muscle mass in young infants.